bipolar disorder

N-Acetylcysteine (NAC) – Inexpensive Treatment for Bipolar Depression

→ November 22, 2011 - 40 Comments

N-Acetylcysteine (NAC) – Inexpensive Treatment for Bipolar Depression

N-acetylcysteine, also known as N-acetyl-L-cysteine or just acetylcysteine is a supplement that shows promise in the treatment of bipolar depression. This is really big news because there are very few drugs, supplements or anything else that show promise in the area of bipolar depression. But N-acetylcysteine (NAC) is even better than most because:

  • N-acetylcysteine is an over-the-counter supplement
  • N-acetylcysteine is cheap
  • N-acetylcysteine has very few known  side effects

What is N-Acetylcysteine (NAC)?

Don’t be scared by the fancy name, just think of NAC as a supplement like omega-3 or vitamin D.

N-acetylcysteine is the N-acetyl derivative of the amino acid cysteine, and cysteine is an amino acid required for you to live. Your body uses it in your brain, for digestion and many other things.

And more interesting for people with bipolar disorder, cysteine is a precursor to glutathione, which is a precursor to glutamate – a neurotransmitter in the brain. Like the neurotransmitter serotonin is made more effective by using selective-serotonin reuptake inhibitor (SSRI) antidepressants, glutamate is increased by taking NAC.

The Research on N-Acetylcysteine (NAC) and Bipolar Disorder

I have been watching the research on NAC and bipolar depression for a while and it looks very promising.

Note that NAC is always used as an add-on medication for bipolar depression and is not used alone.

  • A recent open-label trial found statistically significant reductions in bipolar depression scores over the course of eight weeks. Improvements in functioning and quality of life were also seen.
  • A randomized double-blind placebo-controlled study found significant reductions in bipolar depression scores. Reduction in depression was seen by week eight but further (“medium to high”) benefits were seen by week 20.

N-acetylcysteine has also been used to treat compulsive behavior (like hair-pulling, trichotillomania and gambling), cocaine craving and cigarette smoking.

How is N-Acetylcysteine (NAC) Dosed? What is the Cost of NAC?

Bipolar Depression and NAC

This is always a call for your doctor but the double-blind placebo-controlled study mentioned above dosed at 1000 mg twice daily. Some studies have gone higher than this.

I pay about $25.00 per month for NAC and I get it from a vitamin shop.

What are the Side Effects of N-Acetylcysteine (NAC)?

This depends on who you ask. In the double-blind placebo-controlled study no side effects were noted as statistically significant but side effects are, of course, possible with any medication. Long-term data is not available on NAC’s safety.

It’s worth noting that in very high doses (much higher than is used in humans) mice were found to develop damage to the heart and lungs.

Natasha Tracy’s Opinion on N-Acetylcysteine (NAC)

In my non-medical opinion, this medication is worth a try for people who have unresolved bipolar depression. Again in my opinion, it is a low-risk option for treatment that really appears to have no downsides.

And on a personal note, I, personally, have found it effective.

Learning More About N-Acetylcysteine

If you’re interested in NAC I encourage you to click on the studies I have linked to and read Dr. Phelps’ write-up on NAC as it contains more detail than I have provided. You may need to provide this information to your doctor as many doctors don’t know about NAC and bipolar depression.

Important Note

This is an informational article and nothing is intended as medical advice. All medications, including supplements should be taken under the care of a doctor only. Please and thank you.


Is There a Cure for Bipolar Disorder, Mental Illness?

→ November 2, 2011 - 15 Comments

Is There a Cure for Bipolar Disorder, Mental Illness?

In the world of mental illness we talk about “response” and “remission” and not cure for mental illness. The reason is very simple – we don’t know of a cure for mental illness. One may exist, but we don’t know of any such cure for bipolar disorder, depression, schizophrenia and other mental illness.

What are Treatment, Response, Remission and Relapse?

The words we use most often are treatment, as in I’m in treatment for bipolar disorder; response, as in I’m responding to treatment for schizophrenia; and remission, as in I’m in remission from depression.

  • Treatment – treatment is whatever is applied to make an illness better such as therapy, medication, mindfulness and so on.
  • Response – response is generally positive or negative and indicates whether a treatment is working. A positive response means you have shown improvement on a given course of treatment, it does not necessarily mean that all your symptoms have disappeared, only that there has been positive movement in some way.
  • Remissionremission is the state in which all or most of your symptoms have “remitted” or gone away. People have remissions from cancer, and many other illnesses as well as mental illness.
  • Relapse – relapse is a state in which the symptoms reassert themselves after a period of successful treatment or remission.

Is There  a Cure for Bipolar Disorder?What is a Cure for Mental Illness?

A cure for bipolar, depression, schizophrenia or other mental illness would be a state of recovery where no more symptoms were present and you were returned to health permanently. This is the one that is contentious in mental illness. Most doctors believe that even once a mental illness goes into remission, relapse is possible, and in some cases, even likely. It is thought that the mental illness – the fundamental neurobiological causes – never go away, but they may be successfully treated for a period of time. This amount of time could be forever, but it most often is not.

So if a disease goes into remission forever, isn’t that a cure?

I guess that depends on who you ask. If you have to be treated for the rest of your life, even if you’re in remission I’d say it’s hard to argue that you’re “cured.” On the other hand, if you get better, taper off treatment, and remain better, then maybe you would consider that a cure. I’d be hesitant to use the word “cure,” personally, but that’s me.

Who Goes Into Long-Term Remission? Who’s Cured of Mental Illness?

That’s a toughie. I’d start out by saying that it’s impossible to know who will go into long-term remission or get “cured” of mental illness, but that isn’t exactly true. We know that people with milder forms of the disease have a much better chance of full remission. We know that you have a better chance at a mental illness “cure” if:

  • You don’t have a family history of mental illness
  • You have a more mild form of mental illness
  • You have a good support system
  • You have access to quality medical (including mental health) care
  • You have had fewer episodes of mental illness in the past

Unfortunately, most of us reading this right now do not fit into this category. It doesn’t mean that you won’t find long-term remission; it just means that you’re not in the most likely group.

Is a Cure for Mental Illness Possible?

Mental illness is not one thing and all mental illnesses are not created equal. Depression isn’t the same as bipolar disorder which isn’t the same as schizophrenia. And with different severity levels, these diseases become, yet again, different.

But in the case of severe mental illness, is there a cure?

No.

Not if you ask me.

[push]I think suggesting there is a cure for mental illness overall just isn’t true. We don’t yet have a cure for mental illness. [/push]

I have no doubt that some people with a mental illness can experience long-term remission and some may even consider themselves “cured.” But I have yet to see a person with schizophrenia make that claim. I have yet to see anyone who suffers from psychosis make that claim. I have yet to see anyone with severe, long-standing symptoms make that claim. So it is possible? Maybe. In some cases. But maybe in those cases the disease just isn’t like the other cases. Maybe they are in a category by themselves. Maybe (undoubtedly) we just can’t recognize who is in that category.

So I wouldn’t want anyone to think that a cure absolutely is or absolutely is not possible for any given person, because I don’t know. But I think suggesting there is a cure for mental illness overall just isn’t true. We don’t yet have a cure for mental illness. We’re just going to have to live with that fact. But that’s OK. It puts us in good company with epileptics, Parkinsonians, diabetics and many, many others.

A Sidenote

As an aside, the closest thing we currently have to a cure seems to be deep brain stimulation. For those who get it, and for whom it works, it seems to “cure” depression. But this treatment is still in its very early research stages.

Sleep and Bipolar Disorder – How I Cured My Insomnia – Guest Post

→ October 27, 2011 - 15 Comments

The Bipolar Burble welcomes Leslie Smile for today’s piece on how she recognized that sleep was affecting her bipolar disorder and how she worked to cure her insomnia.

  
I’ve lost many hours holding the wall up with my glazed stare. Unable to calm my mind yet unable to focus my thoughts clearly, I’ve been sleepless for days on end. I would go on through my days like a zombie. “Just keep going,” I’d tell myself. Some days I would come home from work and collapse on my bed until the next morning. I would wake grouchy, confused and still tired. Insomnia doesn’t keep you awake permanently… just until you crash.

Insomnia’s Effects on My Life

[push]I’ve always envied people who sleep easily. Their brains must be cleaner, the floorboards of the skull well swept, all the little monsters closed up in a steamer trunk at the foot of the bed. ~ David Benioff[/push]

The tired feeling morphed into a bone deep lethargy; an energy sucking, crippling fatigue drained me. I began to feel like I could barely survive. I had begun the dip into major depression and bipolar behaviors. I don’t blame my mental illness on my poor sleep nor do I blame my sleeplessness entirely on my mental illness but as I’ve come to learn bipolar disorder and insomnia affect each other in such a way both deserve the attention and respect of proper self-care and good sleep hygiene.

What Didn’t Help My Insomnia and Bipolar Disorder

I had no concept of proper sleep hygiene. First I tried over-the-counter sleep aids, then doctor prescribed sleep aids. Some worked briefly but didn’t give me any sense of being in control of my mental health as their reliability was sketchy at best. Band-Aid solutions were not enough. What could I do?

How I Changed to Help Cure My Insomnia

I rarely gave myself the time for all the things my morning contained. This meant I constantly woke feeling rushed (a very anxiety inducing way to start the day). Focused on getting past insomnia, I started by taking my medications at the same time every day. I made my mornings peaceful waking experiences without coffee. (No coffee?! This was initially a cruel form of torture advised by my doctor, naturopath, and various sleep information rich websites alike.)

Mental Health and Sleeping ProblemsI Had to Want to Cure My Insomnia

At bed time, calming a worrying mind takes practice and effort. Quieting a busy, synapse-firing brain is tricky and left me feeling hopeless at times. Staring at the wall, numb and dissociated from wakefulness and sleep alike is dangerous. I had to want to change before my sleep habits started to improve. Maybe out of desperation or out of new found knowledge I wanted to change.

Training my brain to shut down and wake up at the same time every day is hard. Setting an unwind time alarm and a bedtime alarm felt a little silly at first. I didn’t want to go to bed at 10:30 pm when House was only half over. But I do want to be able to sleep well most nights. My health is more important than House.

More Ways I Cured My Insomnia

I added more artillery to my sleep war chest over time building a stronger defense against insomnia:

  • I removed the clock and any direct light from my sleep area. So many gadgets to hide with their tempestuous glow. No more looking at the clock and being exasperated at the hour I find myself *still* awake.
  • I take my relaxation techniques to bed. Deep breathing, and deep muscle relaxation exercises help put me in the sleep zone.
  • I eat breakfast. It helps keep me from going back to bed and helps my mood too.
  • I start my day with a big glass of cool water instead of fake fuelling myself with sugar and caffeine (did I mention that really sucked at first?).
  • I get out of bed after nine hours. Many people operate fine on seven hours of sleep. Good for those people. If I get up before the ninth hour I’ll take a cursed nap. These are terrible things that I love.
  • I don’t nap. Or I try not to. If I’m tired I try to be aware of that as I continue through my day/evening but it’s good to finish the day tired. That’s an almost guaranteed good night’s sleep. I skip the nap when I can.

Insomnia, Sleep and Me Now

I fall asleep a little easier these days. With the addition of the help of a new medication I’m on for my other mental health issues, I find myself drowsy near the same time nightly.

I still have to force myself many days to get to the kitchen and drink that glass of water. It takes time to make habitual changes. For me, insomnia really is a result of the culmination of habits surrounding my sleep (known as sleep hygiene). I’m sleeping more often than not these past couple weeks and that is an accomplishment. I’m finding the will to start doing the things I love again. I’m learning to follow my bliss in life. It’s the simple things that make the difference, like a good night’s sleep.

Leslie is a mental health patient in Atlantic Canada. She voices her experience getting healthy on Twitter, @SaltySmile. She is passionate about social justice issues, reading, writing, learning and sharing. Contact her at mysaltysmile@gmail.com.

 

Coffee Good for Depression. Sybil Revealed. Bipolar Questions Answered. – 3 New Things

→ October 16, 2011 - 4 Comments

Keep up with mental health news. Three new things in mental health to learn this week:

  • The more coffee (caffeine) your drink, the less likely you’ll be depressed
  • Clinical records of real-life Sybil (part of the basis of “multiple personality disorder”) show likely falsehoods and unethical treatment
  • Get your bipolar questions answered by a clinical psychologist

More Caffeine Decreases the Risk of Depression

This is one of the most marvellous pieces of mental illness information I have heard in a long time – caffeine (coffee) consumption is inversely related to depression. (More on effects of caffeine on mental illness.) In other words, the more coffee you drink the less likely you are to be depressed! Crazy, no?

Well, I guess no. According to a 10-year study of 50,739 women, the women who drank more caffeine were less likely to be depressed. Compared to depressed women who drink one or less cups of coffee per week:

  • The relative risk of depression was 0.85 for women consuming 2-3 cups of coffee per day
  • The relative risk of depression was 0.8 for women consuming 5 or more cups of coffee per day
  • (No increase or decrease in risk was seen in those who drank decaffeinated coffee.)

Increased Caffeine Decreases Depression RiskThat means that women who drank more than 5 cups of coffee per day had even less risk of being depressed than those who drank 2-3 cups of coffee per day. It’s astounding, really.

Now, I’m not suggesting you buy a Starbucks or anything, but the data is quite incredible. I know one thing, I’m not skipping my morning coffee.

(According to their data, 2,607 cases of depression were identified. That number seems really low so they may have set their bar quite high for what qualifies as “depression” and thus this relationship may really exist between caffeine and severe depression, I’m not sure.)

Real Story Behind Sybil and Multiple Personality Disorder

One the more popular pieces on the Bipolar Burble written by a guest author was Everything You Know About Dissociative Identity Disorder is Wrong by Holly Gray. In this article, Holly exposes some of the myths about dissociative identity disorder – previously known as multiple personality disorder. And, of course, multiple personality disorder was made famous by the book (and movie) Sybil.

Dissociative Identity Disorder and Symbil

Provided by Wikipedia

As Holly points out, there aren’t really “multiple personalities” or multiple people, inside one person with dissociative identity disorder, so the name was a misnomer and based on some very bad information – much of it from Sybil’s very public case. And A Girl Not Named Sybil in the New York Times aims to explore some of the problems with the story of Sybil, now known to actually be a woman named Shirley Mason.

Among other things, Mason’s therapist prescribes drugs in an unhealthy (addiction promoting) way and repeatedly administers sodium pentothal (truth serum as it has been commonly known). The article seems to suggest that Mason may have been making some things up and her therapist may not have been acting ethically, possibly making Mason actually worse. Do read the article. It goes to show you how one very loud, possibly untrue, case can overshadow reality.

Bipolar Question and Answer Session

Now, really, I’m your question and answer girl. You have questions, I have answers. But perhaps you’d prefer someone with a Phd to talk to. Well then you might try Dr. Rob (yes, I know). He’s hosting a live bipolar question and answer session on October 24th. You can submit confidential questions now or do so during the live session. If I can find the time I might just take a gander myself.

Bipolar Terminology: The Difference Between Bipolar I and Bipolar II

→ October 5, 2011 - 53 Comments

Bipolar Terminology: The Difference Between Bipolar I and Bipolar II

Sometimes I get so wrapped up in research, I forget some people are looking for some introductory information like the different between the types of bipolar disorder. Thanks to commenter on my GooglePlus feed, I was reminded of this fact and I decided to answer her question here so I could give her more detail.

Bipolar Terminology

Unfortunately, within bipolar terminology resides more bipolar terminology. But don’t be scared, I have information on most terms on my site and I shall try to walk gently into that good encyclopedia.

But let’s try to get rid of the terminology confusion: What is the difference between bipolar type I and bipolar type II?

Read more

Bipolar’s Not Bad Enough – We Beat Ourselves Up – Advice

→ October 3, 2011 - 16 Comments

Part of having a mental illness like bipolar disorder is having a brain that hates you. A brain that overreacts to the slightest perceived imperfection. All it takes is believing that we have done something wrong for our brain to see it as a capital offense and spend hours or days beating ourselves up about it.

This is pretty de rigueur for someone with a mental illness (especially depression or anxiety).

Bipolar Making You Beat Yourself UpBeating Yourself Up Over a Perceived Error

And this morning I got an email from someone in just this situation. This person had spent some time with friends and felt they were overly-anxietious, overly-talkative, overly-hyper and so on. And unfortunately, this person was using this perception to beat themselves up.

This is wrong. Please read my response to this person. I hope it will help anyone in this situation (which includes me, from time to time).

To those who would beat themselves up over a perceived mistake:

First of all, be gentle with yourself. This is a Buddhist concept. You deserve to be treated as well as you treat others. You’re being far too harsh.

You have to understand that your perception of what happened might be skewed. You may not have been nearly as anxious, hyper, talkative, and so on, as you think. And even if you were, others may not have found that a negative.

You’re basically beating yourself up for something that might not have even happened!

Additionally, try to remember that you’re not perfect, none of us are. Even if you weren’t perfect yesterday, that’s OK, because none of us meet that standard. These people care for you and aren’t going to judge you nearly as harshly as you’re judging yourself because they’re not perfect either.

You try your best, every day, which we all do, and that is good enough. Your flaws are OK. Your imperfections are OK. You didn’t do anything wrong or bad it’s just your brain trying to make you think you did. Brains tend to lie. You were just like everyone else. Which is what we all are.

Try to remember to be gentle. It’s rough out there. You deserve to be your own best friend.

Free rTMS, Brain Changes in Depressed Females, Why Anti-Benzodiazepine? – 3 New Things

→ September 29, 2011 - 4 Comments

Last week I didn’t post three new things but don’t take that to mean I wasn’t learning because I certain was, and always am. For this week I have these three new pieces of information to share:

  • Repetitive transcranial magnetic stimulation (rTMS) treatment for depression to be free for (some) Canadians
  • Brain changes are noted in depressed females
  • Why are some doctors anti-benzodiazepine?

1. Free rTMS in Manitoba (Canada)

RTMS stands for repetitive transcranial magnetic stimulation and is a treatment for treatment-resistant depression. RTMS is considered a neurostimulation therapy, like electroconvulsive therapy (ECT), but is non-invasive. RTMS has its pros and its cons.

  • Pros – rTMS is drug-free, has few side-effects and can produce remission from depression in some people
  • Cons – rTMS is expensive, intensive and its therapeutic effects are generally temporary

Cost of RTMS

Most people don’t get rTMS due to the cost. Repetitive transcranial magnetic stimulation requires 2 sessions per day for 10 days (weekends off) plus and additional possible 5-10 sessions depending on the reaction to treatment. Needless to say, this is one expensive therapy. In Canada that works out to $5000 – $7500 and in the States lord only knows how much.

Differences in Brains of Depressed WomenFree RTMS

And Manitoba is taking the very civilized step forward of offering rTMS as part of the public health care system, which is how it should be. The only reason why it isn’t is cost. You can get rTMS in Canada, but this is the first time I’ve heard of it being free.

Congratulations to Manitoba for taking a step forward in helping people with a mental illness. I hope this is the sign of things to come across the country.

2. Brain Changes Noted in Depressed Females

Women are twice as likely to develop depression as men but no one knows why. This study takes a look at female brains to look for biological identifying markers between depressed brains and well brains.

. . . depressed women had a pattern of reduced expression of certain genes, including the one for brain-derived neurotrophic factor (BDNF), and of genes that are typically present in particular subtypes of brain cells, or neurons, that express the neurotransmitter gamma-aminobutyric acid (GABA.) These findings were observed in the amygdala, which is a brain region that is involved in sensing and expressing emotion.

BDNF and GABA in Depressed Brains of Women

BDNF is something I’ve mentioned before as to a biological cause of depression. Yes, just another fact to chalk up for all the people saying depression is just “in your head.”

And work toward identifying the gene that contributes to depression:

. . . researchers tested mice engineered to carry different mutations in the BDNF gene to see its impact on the GABA cells. They found two mutations that led to the same deficit in the GABA subtype and that also mirrored other changes seen in the human depressed brain.

I keep telling people: We’re getting closer to effective treatments and understanding every day.

3. The Religion of Benzodiazepines – Why Some Doctors Don’t Prescribe Benzos

I’ve taken benzodiazepines (benzos) of one type or another for a decade and never once had a problem with them, but many people do develop tolerance, dependence and drug-seeking behavior around this type of medication.

My opinion is that benzodiazepine medications can be used quite safely when properly handled, but that some people have the tendency to get addicted to medications, and for them, these medications may be contraindicated. In other words, it’s down to the individual and prescription of benzos cannot be characterized as “bad” or “good” in a blanket statement.

I plan on writing a whole article about this, but if you’d like a sneak peek about why some doctors are anti-benzodiazepine, check out this article in Psychiatric Times.

Until next week all, when I shall learn more and do better.

I Can’t Get Pregnant – I Have Bipolar Disorder

→ September 22, 2011 - 221 Comments

I Can’t Get Pregnant – I Have Bipolar Disorder

Should People with Bipolar Have Kids?

I am now 33. And that’s one of those ages where the biological clock starts to have a deafening ring. But the thing is I can’t get pregnant; I can’t have kids; I have bipolar disorder.

Read more

Breaking Bipolar Articles You Should Read

→ September 20, 2011 - 10 Comments

Admit it – you haven’t kept up with your bipolar reading. Come on. I know it. I can barely keep up and I write the bipolar articles.

Luckily for you, I like you a lot, and I’m happy to give you a little cheat sheet on what’s been getting attention at Breaking Bipolar. We’ve got mental illness and higher education, mental illness and physical pain, how to tell if it’s a med side effect and oh so much more.

Breaking Bipolar at HealthyPlace by Natasha Tracy

Articles Breaking Bipolar Over at HealthyPlace

Here is a sampling of recent articles written for Breaking Bipolar at HealthyPlace to which people have positively responded:

Popular Articles at the Bipolar Burble

And just in case you haven’t been glued to the Bipolar Burble, here are a few things you should read here:

Let me know what you think and of course feel free to suggest topics any time.

New Antipsychiatry Discussion, L-Theanine, Rapid Cycling Markets – 3 New Things

→ September 1, 2011 - 2 Comments

This week’s three new things include:

  • A new supplement that may help brain health and mental illness: l-theanine
  • A poor comparison between rapid cycling bipolar disorder and the financial markets
  • A new discussion of antipsychiatry

1. New to Me: L-Theanine as an Antidepressant

Maurya, a commenter, asked if I knew anything about l-theanine. Well, I didn’t. Every once in a while even I run across something of which I haven’t heard.

So, for those of you in my boat, here’s a bit about l-theanine:

As always, as this is a supplement it is not FDA-controlled and there is no guarantee as to what you will get in the bottle and you should never take any supplement without first checking with your doctor.

More studies on l-theanine can be found here.

Rapid Cycling Brings Out Stigma Comments2. What I Don’t Like – A Half-Assed Comparison Between Bipolar Disorder and the Financial Markets

I’m a writer so questionable metaphors irk me. And rapid cycling bipolar disorder as a metaphor for the financial marketplace? Really? That’s a whole new level of irk.

If you really want to make that comparison then the bulk of the article should be on the markets and not mental illness, and not the other way around like Lloyd I. Sederer M. D. did in Rapid Cycling Bipolar Disorder: In the Office and On ‘The Street.’

Comments of Mental Illness Stigma

All this poorly-written article did was confuse people and elicit a bunch of anti-bipolar comments like:

“The foundation of the Bi-Polar epidemic is based in suppressed biochemist­ry, outdated understand­ing of genetics and a complete misunderst­anding of our true spiritual nature.”

And,

“So how exactly is this different from saying some people dramatical­ly over-react to external circumstan­ces?

Sorry folks, but this one goes into the notebook for the next philosophi­cal discussion of “medicaliz­ation” as a way of discussing deviance.”

Seems to me he just wanted to use mental illness as an eyeball-grabber, tricking readers onto a topic they would never otherwise read – with the extra bonus of eliciting remarks of stigma.

Gee, thanks.

3. What I Find Interesting – New Discussion of Antipsychiatry

As you might know, I’m not a fan of antipsychiatry folks. I have written a lot on this topic and I’m sure I will write much more in times to come. But I can across this article, Getting It From Both Sides: Foundational and Antifoundational Critiques of Psychiatry which has an interesting discussion of antipsychiatry viewpoints.

Two Sides to Antipsychiatry

It astutely notes there are two sides of antipsychiatry – those who feel that nothing can be defined and thus no mental illness can be defined; and those who feel illness is rigidly defined and mental illness doesn’t meet that definition.

Both sides, as the author says,

“. . . have had the effect of discrediting and marginalizing psychiatry and of delegitimizing psychiatric diagnosis and nosology.”

It’s a very intelligent view of antipsychiatry criticism that is elevated far beyond what we normally see online. Check it out.

Until next week: Smarter and Better.

Bipolar Disorder – When to Get Off Antidepressants

→ August 31, 2011 - 18 Comments

I try not to give medical advice here because I am not a doctor. But so many people ask me about this I felt I had to address getting off antidepressants without withdrawal. So many people with bipolar disorder (depression and others) need information about getting off psych meds and they are not getting it from their doctors.

This is the first in a three-part series:

  1. When to Stop Antidepressants in Bipolar Disorder
  2. How to Stop Antidepressants in Bipolar Disorder While Minimizing Withdrawal
  3. How to Stop Taking venlafaxine (Effexor) and Desvenlafaxine (Pristiq) – as they are particularly nasty to get off

This is an informational article only and should not be considered a recommendation. Talk to your doctor before any and all changes to your treatment. I’m not kidding about this.

These recommendations are primarily from PsychEducation.org and Dr. Jim Phelps with some commentary by me.

Bipolars Shouldn’t Take Antidepressants

Some doctors are on the fence about this, but more and more bipolar specialists are recommending people with bipolar disorder not take antidepressants. There are lots of reasons for this, and I have to tell you, they are compelling.

Why Shouldn’t People with Bipolar Disorder Take Antidepressants?

Some reasons people with bipolar shouldn’t take antidepressants:

  • Antidepressants may not work in bipolar disorder – believe it or not, the literature is mixed on how well antidepressants even work for bipolar depression.
  • Antidepressants can induce mania or hypomania (known as switching) – most of us have seen this and it happens all the time to bipolars who are prescribe antidepressants by non-psychiatrists because they just don’t understand the danger. And it is very dangerous because once switched, this type of mania or hypomania can be treatment resistant.
  • Antidepressants can induce rapid-cycling or mixed moods – same as above, this cycling can be treatment-resistant.
  • Antidepressants can worsen a bipolar’s illness overall – this is more controversial and I suspect varies case by case.

Bipolar Disorder and No AntidepressantsTo be clear some people with bipolar disorder will always need antidepressants temporarily, or long term, for their mood, but more and more, doctors are saying to avoid them whenever possible. (Alternatives will be presented in a future article.)

When to Stop Taking Antidepressants

Here are some guidelines from Dr. Phelps about when to stop taking antidepressants in bipolar disorder:

  1. If they have been on antidepressants a short time, I stop them.
  2. Less than a week, stop; two weeks, cut in ½, a week later stop.
  3. Likewise, if they just increased their antidepressants dose I will do the above, decreasing to their previous dose and get rid of the rest later.
  4. If manic or severely hypomanic, get rid of antidepressants now.  Usually can stop abruptly.
  5. If cycling or mixed get rid of the antidepressants.
  6. If they are not getting better after several add-on meds then slowly decrease.
  7. There are more exceptions to the above rules than there are rules.

When to Stay On an Antidepressant if You’re Bipolar

More guidelines from Dr. Phelps: When a bipolar should stay on an antidepressant:

  • If the patient is doing well, no mixed state symptoms or cycling, leave it.
  • I usually wait until the patient is doing better to much betterto stop an antidepressant; why:
  • Trust is an issue.  If the first thing we do is make them suffer more they will be unlikely to stay around long and may not even go to another psychiatrist.
  • Even though we know the antidepressant is causing harm often time the patient thinks either the antidepressant is helping or every time they try to go off they feel much worse.
  • Waiting until they are better is usually a good thing.
  • Also waiting longer usually means that the patient is going to be more educated about bipolar in general.

When to Get Off an Antidepressant Recommendations

I think Dr. Phelps’ recommendations are good ones, otherwise I wouldn’t have them here, but note where he says there are more exceptions than he has listed, so keep in mind, you might fall into one of the unlisted exceptions.

And I think the part above where Dr. Phelps talks about trust and making sure the patient is better before messing around with their cocktail is key. It shows he’s respecting the patient and their health, not to mention the doctor-patient relationship which is very important.

Talking to Your Doctor about Getting off Antidepressants is Scary

I know it’s scary to think about going off antidepressants, even if you do think they are causing problems. But think about it, discuss it with your doctor and make the right decision for you. And don’t do anything until you read the next part about how to get off antidepressants without withdrawal.

Bipolar Disorder – Getting off Antidepressant Series

  • Bipolar Disorder – When Not to Take Antidepressants

Coming up:

Mixed Bipolar Disorder – How to Treat Mixed Mood Episodes

→ August 23, 2011 - 23 Comments

In the final installation of my mixed moods series, I talk about how to treat mixed moods in bipolar disorder. If you need a refresher on mixed moods in bipolar 1 or bipolar 2, see the first three articles in this series:

Treating Mixed Moods in Bipolar 1 – Mixed Mania

We know most about treating mixed moods in bipolar type 1 as that’s what has been classically defined as a mixed mood in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Because mixed moods in bipolar disorder type 1 are considered a type of mania, one could think of treating them in the same way bipolar mania is treated. Typical mania treatments include:

  • Lithium
  • Some anticonvulsants
  • Antipsychotics (normally atypical)
  • Benzodiazepines (for acute anxiety, commonly seen in mania and mixed moods)

Often a combination of an anticonvulsant and an antipsychotic is used.

FDA-Approved Drugs for Treating Mixed Moods in Bipolar 1

Since mixed moods are defined in the DSM, there are specific medications approved by the Food and Drug Administration (FDA) to treat mixed mania. FDA-approved drugs for treating mixed moods in bipolar disorder type 1:

  • Carbamazepine extended release (Equetro)
  • Aripiprazole (Abilify)
  • Ziprasidone (Geodon)
  • Risperidone (Risperdal)
  • Asenapine (Saphris)
  • Olanzapine (Zyprexa)

Bipolar Type 1 and Mixed Mood TreatmentWhy lithium didn’t make the list I’m not entirely sure;* because, as I’ve mentioned, mixed moods and acute anxiety carry a significant risk of suicide and lithium seems to have a particularly strong anti-suicide effect.

Electroconvulsive therapy (ECT) is also indicated for the treatment of bipolar disorder mixed moods.

Treating Mixed Moods in Bipolar 2

As I mentioned in the article on mixed moods in bipolar disorder type 2, mixed moods can either have hypomania or depression as the primary mood. This primary mood then, dictates the type of treatment chosen.

Treating Mixed Hypomania

According to this two-part Psychiatric Times article by Steven C. Dilsaver, MD, mixed hypomania in bipolar type 2 can be treated similarly to treating a mixed mood in bipolar type 1.

Specifically noted is the concern of acute anxiety during mixed hypomania and the fact not all patients readily admit to psychological and physical symptoms of anxiety. However, this is critical information to your doctor and should always be offered, even if not specifically asked.

Other mixed hypomania treatment tips include:

  • Comorbid (co-occurring) anxiety may decrease the effectiveness of mood-stabilizing agents, so benzodiazepines may be a better choice.
  • Not treating anxiety aggressively can reduce overall long-term treatment outcomes.

Treating Mixed Depression

Mixed depression is particularly hard to treat as mixed moods often predict a lack of response to antidepressants, not to mention the fact that antidepressants can make hypomanic or manic symptoms worse.

A suggested treatment strategy for mixed moods in bipolar 2 with the primary mood of depression is the following:

  • Begin by suppressing hypomanic symptoms by using an mood stabilizer or antipsychotic (antipsychotics may work in 1-2 weeks)
  • Start medication at low doses and titrate (raise the dose) quickly – this is generally necessary due to the severity of mood symptoms
  • If depressive symptoms persist after response to the above medication, add a selective serotonin reuptake inhibitor (SSRI) antidepressant very slowly while watching for signs of hypomania – this requires very close monitoring and likely weekly doctor visits (impossible for some, obviously)

This is very similar to what many doctors are now recommending for bipolar disorder type 2 in general. First, stop the cycling (or hypomania) and see if that also corrects the depression. Avoid the use of antidepressants whenever possible.

Preventing Mixed Depression in Bipolar Type 2

How To Prevent Bipolar Disorder Mixed Moods

Obviously, no one can guarantee prevention of any mood, but there are some recommendations given in the article, as people with mixed depression are known to be at high risk for reoccurrence.

Tips on preventing mixed depression in bipolar 2 include:

  • Lamotrigine is the favorite prophylactic medication as it seems to prevent depression without being an antidepressant
  • Ongoing scheduled benzodiazepine doses can help prevent panic attacks^
  • A combination of an antipsychotic, plus lamotrigine, plus a benzodiazepine is often “highly effective” (words Dr. Dilsaver’s)
  • Lithium is known to be a highly preventative agent; however, in many cases divalproex (Depakote) is superior and has fewer side effects

Series on Mixed Moods in Bipolar Disorder

Whew. OK, there turned out to be a lot to know about mixed moods in bipolar disorder. I hope you learned something reading it as I certainly did writing it.

For your convenience, here are the links to the other three parts in the series:

——————————————————————————————————————————-

Notes

* I suspect there wasn’t enough money to be made on a generic drug to fund the studies, especially when doctors are going to use it anyways.
^ Yes, I know, long-term (sometimes any term) benzodiazepine use is controversial. Personally, I’m not against them and neither are many doctors – when used responsibly.

Reference

Psychiatric Times, Mixed States in Their Manifold Forms. Part one and part two.
Page 15 of 19« First...5...1213141516171819